| 摘要: |
| 目的：观察健脾补肾活血方治疗脾肾两虚、痰湿瘀阻型多囊卵巢综合征胰岛素抵抗(PCOS-IR)的临床疗效和安全性。方法：将100例脾肾两虚、痰湿瘀阻型PCOS-IR患者随机分为治疗组和对照组，每组各50例。对照组采用生活方式指导联合二甲双胍治疗，治疗组在对照组的基础上予以健脾补肾活血方治疗，2组均治疗12周。观察2组综合疗效，中医证候积分，胰岛素抵抗指标［空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(HOMA-β)、定量胰岛素敏感性检测指数(QUICKI)、李光伟指数、Bennett胰岛素敏感性指数(Bennett ISI)］，糖脂代谢指标［空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)］，体质量（BMI），性激素指标［黄体生成素(LH)、卵泡刺激素(FSH)、LH/FSH、雌二醇(E2)、血清总睾酮(TT)、性激素结合球蛋白(SHBG)、游离雄激素指数(FAI)、血清游离睾酮(cFT)］，月经周期评分及不良反应发生情况。结果：治疗过程中脱落5例，最终治疗组纳入47例，对照组纳入48例。总有效率治疗组为93.6%(44/47)，对照组为77.1%(37/48)，2组比较，差异有统计学意义(P<0.05)。治疗后治疗组中医证候积分、胰岛素抵抗各项指标、FPG、LDL-C、BMI、TT、FAI、月经周期评分均较治疗前改善(P<0.05)，且其中医证候积分、FINS、HOMA-IR、QUICKI、李光伟指数、BMI、月经周期评分改善程度均优于对照组(P<0.05)。2组均未发生严重不良反应，药物安全性良好。结论：健脾补肾活血方联合西医常规疗法能有效改善脾肾两虚、痰湿瘀阻型PCOS-IR患者胰岛素敏感性、糖脂代谢紊乱、中医证候及月经不调。 |
| 关键词: 多囊卵巢综合征 胰岛素抵抗 脾肾两虚、痰湿瘀阻型 中西医结合疗法 健脾补肾活血方 |
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| Clinical effect of spleen-strengthening，kidney-tonifying，and blood-activating prescription in treatment of polycystic ovary syndrome-insulin resistance：An analysis of 47 cases |
| WANG Xuening,SUN Jiaxing,AN Xiaofei |
| (The Affiliated Hospital of Nanjing University of Chinese Medicine，Nanjing 210029，Jiangsu，China) |
| Abstract: |
| Objective：To investigate the clinical effect and safety of spleen-strengthening，kidney-tonifying，and blood-activating prescription in the treatment of spleen-kidney deficiency and phlegm-dampness stasis of polycystic ovary syndrome-insulin resistance (PCOS-IR).Methods：A total of 100 patients with spleen-kidney deficiency and phlegm-dampness stasis of PCOS-IR were randomly divided into treatment group and control group，with 50 patients in each group.The patients in the control group received lifestyle guidance and metformin，and those in the treatment received spleen-strengthening，kidney-tonifying，and blood-activating prescription in addition to the treatment in the control group；the course of treatment was 12 weeks for both groups.The two groups were observed in terms of overall response，traditional Chinese medicine (TCM) syndrome score，insulin resistance indices (fasting insulin ［FINS］，Homeostasis Model Assessment of Insulin Resistance ［HOMA-IR］，homeostasis model assessment β-cell function，quantitative insulin sensitivity check index ［QUICKI］，insulin sensitivity index (ISI) proposed by Li Guangwei，and Bennett ISI，glucose and lipid metabolic markers (fasting plasma glucose ［FPG］，total cholesterol，triglyceride，low-density lipoprotein cholesterol ［LDL-C］，and high-density lipoprotein cholesterol ［HDL-C］)，body mass index (BMI)，sex hormone indicators (luteinizing hormone ［LH］，follicle-stimulating hormone ［FSH］，LH/FSH ratio，estradiol，serum total testosterone ［TT］，sex hormone-binding globulin，free androgen index ［FAI］，and serum calculated free testosterone)，menstrual cycle score，and adverse reactions.Results：Five patients were lost to follow-up during treatment，and finally there were 47 patients in the treatment group and 48 patients in the control group.There was a significant difference in overall response rate between the treatment group and the control group ［93.6% (44/47) vs 77.1% (37/48)，P<0.05］.After treatment，the treatment group had significant improvements in TCM syndrome score，insulin resistance indices，FPG，LDL-C，BMI，TT，FAI，and menstrual cycle score (P<0.05)，and compared with the control group，the treatment group had significantly better improvements in TCM syndrome score，FINS，HOMA-IR，QUICKI，ISI proposed by Li Guangwei，BMI，and menstrual cycle score (P<0.05).There were no serious adverse reactions in both growps,indicating good drug safety.Conclusion：In patients with spleen-kidney deficiency and phlegm-dampness stasis of PCOS-IR，spleen-strengthening，kidney-tonifying，and blood-activating prescription combined with conventional Western medicine treatment can effectively improve insulin sensitivity，glucose and lipid metabolism disorders，TCM syndrome，and irregular menstruation. |
| Key words: polycystic ovary syndrome insulin resistance spleen-kidney deficiency,phlegm-dampness stasis integrated traditional Chinese and Western medicine therapy spleen-strengthening,kidney-tonifying,and blood-activating prescription |
